Multiple Myeloma: Treatment Choices

There are many types of treatment for multiple myeloma. Which may work best for you? It depends on a number of factors. These include the location and stage of your cancer, and how likely it is to grow and spread quickly. Factors also include whether or not you're having symptoms, your age and overall health, what side effects you’ll find acceptable, and your preferences.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function during and after treatment, as well as if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to get. It can be hard to make this decision. It’s important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to learn more about your options. You may want to get a second opinion before deciding on your treatment plan. You may also want to involve your family and friends in this process.

Understanding the goals of treatment for multiple myeloma

At this time, treatments for multiple myeloma are not able to cure it, but they can often keep it under control for many years. Treatment can also improve your quality of life by helping to control the symptoms of the disease. The goals of treatment can include one or more of these things:

Destroy multiple myeloma cells

Stop or slow the growth or spread of myeloma cells

Ease symptoms from the cancer. These may include bone pain or problems from having too much calcium in your blood.

Types of treatment for multiple myeloma

Many types of treatment can be used for multiple myeloma. And different combinations of treatment can be used, depending on a number of factors. Each treatment has its own goals. Here's an overview of each type of treatment:

Active surveillance

The goal of active surveillance is to watch the myeloma but not treat it right away. This may be done when the cancer is growing slowly and won't likely cause problems for a long time. This approach is often a good option for myeloma that's not causing any symptoms. (This is called smoldering myeloma.)

Your healthcare provider may recommend this if you don't have symptoms. Or he or she may suggest it if you don’t have damage to your kidneys or bones and you have little or no anemia.

Active surveillance means you'll see your healthcare provider every few months for check-ups. These may include blood and urine tests. You may also get imaging tests, such as X-rays. If the cancer starts growing more quickly, your healthcare provider might suggest that you start active treatment.

Chemotherapy and other medicines

This is the use of medicines that kill cancer cells. Different kinds of medicines can be used to treat myeloma. The goal is to control the cancer for as long as possible.

Immunotherapy

This treatment "turns on" the immune system so it fights the cancer. Or, it uses man-made immune proteins called monoclonal antibodies to attack the cancer cells. Different types of immunotherapy can be used. The goal is to keep the cancer under control for as long as possible.

Radiation therapy

The goal of this treatment is to ease symptoms such as bone pain, especially if medicine treatment isn't working.

Radiation can also be used as the main treatment for a single collection of myeloma cells. This is called a plasmacytoma.

Stem cell transplant

The goal of a stem cell transplant is to kill as many of the cancer cells as possible to help you live longer. You’ll get high doses of chemotherapy. The chemo kills almost all of the cells in your bone marrow, including the cancer cells. But it also kills normal bone marrow cells. This can lead to life-threatening side effects. To get around this, you get new blood-forming stem cells after treatment.

Most often the stem cells are taken from your own bone marrow (and frozen) before treatment. This is known as an autologous stem cell transplant. Less often, the stem cells might come from a donor, such as a close relative. This is called an allogeneic stem cell transplant. After treatment, the stem cells are put into your body in a process that's like getting a blood transfusion. Over time, these stem cells rebuild your bone marrow.

Supportive care

Your healthcare provider may suggest treatments that help ease your symptoms, but don’t treat the cancer. These can sometimes be used along with other treatments. Or your healthcare provider may suggest supportive care if he or she believes that treatments are more likely to do you more harm than good.

Examples of supportive care include antibiotics to treat or help prevent infection and a blood thinner to help prevent blood clots. Talk to your healthcare provider about the goal of each treatment you get.

Clinical trials for new treatments

Researchers are always looking for new ways to treat multiple myeloma. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials that might be right for you.

Talking with your healthcare provider

At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.